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Glucose Tolerance during Moderate Alcohol Intake: Insights on Insulin Action from Glucose/Lactate Dynamics

Department of Clinical and Experimental Medicine (A.A., L.G., S.d.K., A.T.), University of Padova Medical School, 35128 Padova, Italy; Department of Preventive Medicine (R.M.W.), Keck School of Medicine, University of Southern California, Los Angeles, California 90089; Institute of Systems Science and Biomedical Engineering (G.P.), National Research Council, 35127 Padova, Italy

Address all correspondence and requests for reprints to: Angelo Avogaro, M.D., Dipartimento Medicina Sperimentale, Policlinico, Via Giustiniani 2, 35128 Padova, Italy. E-mail: . angelo.avogaro{at}unipd.it

Abstract

Moderate alcohol (ETOH) intake has been associated with a significant reduction in risk for infarction among general populations. In this study, we assessed the effects of low-dose ETOH (40 g over 3-h period as vodka) on the interaction between glucose (G), insulin, and lactate (L) during the insulin-modified frequently sampled iv glucose tolerance test (FSIGT) (0.3 U/kg body weight between 20–25 min) in eight normal volunteers. In the control (C) study, water was administered. An insulin-independent two-compartment model was used to describe G and L kinetics. Insulin sensitivity (S_I) was significantly higher in the ETOH study than in the C study (2.49 ± 0.52 vs. 0.92 ± 0.20 10^-4 min^-1µU^-1ml, C vs. ETOH; P = 0.0391). No significant differences were observed in G effectiveness (0.029 ± 0.004 vs. 0.033 ± 0.004 min^-1). Blood L levels were higher during FSIGT when ETOH was administered [area under the curve (AUC), 201 ± 16 vs. 123 ± 23 mmol/liter in 240 min; P = 0.0001]. The dynamic analysis of blood L concentrations showed that ETOH also significantly decreased L clearance (0.0016 ± 0.0011 vs. 0.0029 ± 0.0002 min^-1; P = 0.0156), whereas no difference was observed for the fractional conversion of the rate of G disappearance to L (0.0033 ± 0.0012 vs. 0.0031 ± 0.0005 min^-1). ETOH decreased baseline plasma FFA concentration; AUC of FFA was markedly reduced with ETOH (65 ± 14 vs. 109 ± 17 mmol/liter in 240 min; P = 0.0063) and inversely correlated with S_I (r = 0.693; P = 0.0029). The amount of C-peptide in 240 min as well as the amounts before and after insulin administration were not different between the two tests. We concluded that G and L kinetics derived from FSIGT shows that moderate ETOH intake: 1) improves insulin action; 2) decreases L clearance; and 3) does not affect ß cell function. Because ETOH at moderate doses has a marked antilipolytic action, it might improve insulin action by improving substrate competition. The present findings suggest that moderate alcohol consumption in the diet should not be discouraged.

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